Basic Information
| Provider Information | |||||||||
| NPI: | 1306578679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRISELL MEMORIAL HOSPTIAL RHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 345 | ||||||||
| Address2: | |||||||||
| City: | NESS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675600345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857985663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 S VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | RANSOM | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675729525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857312295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2022 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | BASGALL | ||||||||
| AuthorizedOfficialFirstName: | LORETTA | ||||||||
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| AuthorizedOfficialTitleorPosition: | RN OFFICE CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7857312295 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 1295369536 | 01 | KS | NPI | OTHER |